DIABETES TECHNOLOGY: ENDLESS CHOICES FOR HEALTHY MANAGEMENT MAKING THE MOST OF MODERN DIABETES TREATMENTS & TECHNOLOGIES JENNIFER C. SMITH RD, LD, CDE DIRECTOR OF LIFESTYLE AND NUTRITION INTEGRATED DIABETES SERVICES (877) 735-3648; (610) 642-6055 JENNIFER@INTEGRATEDDIABETES.COM
A LITTLE BIT ABOUT ME Type-1 Diabetes for 28years Registerd Dietitian and Certified Diabetes Educator for 10+ years Athlete Successfully completed TWO 70.3 Half Ironman events and multiple ½ marathons, one full marathon and century cycling events Writer - Diabetes Sisters, InsulinNation, Byram Health Newsletter, Diabetes Daily Lecture nationally on various topics including nutrition/carb-counting, sports nutrition and insulin pump use. I am vegetarian and love cooking and baking with attention to special diet needs (vegan, GF).
TECHNOLOGY CHANGES EVERYTHING.. 30 years ago.. Today..
THANKFULLY THIS INCLUDES DIABETES! THE EVOLUTION OF GLUCOSE MONITORS
DIABETES CHANGES: BLOOD GLUCOSE MONITORING 30 Years Ago Today 10+ microliter square sample 2-3 minutes Coding, wiping, blotting, etc Many interferences 0.3-0.5 l sample 5 seconds Code-free LED, color screen Improved accuracy Data storage/downloadable Plug & Play, mobile device link Ketone test capability
DIABETES CHANGES: LANCING 30 Years Ago Today Spring-Loaded AutoLet 25-gauge lancets 30-33 gauge lancets 38g,.75mm peds lancet Depth adjustment Multi-lancet head option Alternate site head option
DIABETES CHANGES: CONTINUOUS GLUCOSE MONITORING 30 Years Ago Today
DIABETES CHANGES: CGM ALARMS 10 years ago Today Medtronic connect Dexcom Share
CGM SHARING AND VIEWING..
WHAT DOES CGM PROVIDE? Numbers Alerts Trends Retro- Analysis
DECISION-MAKING BASED ON TREND INFORMATION Self-Care Choices o To snack? o To check again soon? o To exercise? o To adjust insulin? Key Situations o Driving o Sports o Tests o Bedtime
DIABETES CHANGES: INSULIN 30 Years Ago Today Animal-Derived NPH, Lente, Ultralente Regular short acting Basal (Lantus, Levemir, Toujeo, Tresiba) Bolus (Humalog, Novolog, Apidra, Humalog U200, Afrezza [inhaled insulin])
DIABETES CHANGES: INSULIN INJECTION 30 Years Ago Today Syringes only 28-gauge, ½ needles 1 or 2-unit markings Pens Ports Mini syringes
PUMP EVOLUTION 1960s (Dr.Kadish) 1970s (Dean Kamen) 1980s
PUMP EVOLUTION Thank goodness for Modern Day Insulin Pumps!!
PUMP INNOVATIONS Minute Basal Adjustments/Temps Bolus Calculators w/iob Prolonged Bolusing Custom Reminders Meter & CGM Links Remote Programming Tubeless Option Color/Touch Screen Databases, Downloading U-500 Capacity New Infusion Devices
DIABETES CHANGES: DATA COLLECTION/ANALYSIS 30 Years Ago Today Web-Based Programs Computer Software Mobile Device Apps
WEB BASED PROGRAMS: * LOGGING AND DATA ANALYSIS: All inclusive Apps for logging: MySugr GlucoseBuddy Glooko Data download and analysis: Medtronic Carelink/Connect Dexcom Studio Software (G4) Dexcom Clarity Software/Reports App (G5) Glooko (download all pumps and Dexcom CGM) Accessible via App for Dexcom upload Diasend (download all pumps and Dexcom G4 - CGM) Accessible via app Diabetik
DIABETES CHANGES: MEDICAL TREATMENTS (OTHER THAN INSULIN) 30 Years Ago Today Amylin GLP-1s Metformin SGLT-2s Victoza
RESEARCH/DEVELOPMENT Group/Company Product Possible time of market availability Medtronic - MiniMed 670G(hybrid closed loop) -Fully Automated Closed Loop Tandem UVA Predictive low glucose suspend or basal closed-loop system DiAs (24 hour or overnight-only, hybrid closed lopp, insulin-only, algorithm embedded in a pump or on smartphone. Current tested systems include Dexcom sensor and Roche/Tandem pumps. Bigfoot Biomedical Goal is to be a pivotal trial in 2016 -US launch 2017? - Following 670G launch - Potential late 2017 DiAs licensed by TypeZero Technologies Large scale clinical trials in 2015 and 2016 will determine market. Animas Predictive Low Glucose Suspend or hypo/hyper minimizer with Dexcom CGM No known date of availability Insulet Roche Plans for involvement in the artificial pancreas - possible development strategy on CGM and algorithm Internal work on a new CGM with potential application to an artificial pancreas device No known date of availability No known date of availability
NUTRITION RESOURCES: Calculation and Tracking Calorie King GoMeals (data from Calorie King) HealthyOut Diabetes Tracker Carbs Control (by Coheso) Calorie Counter Pro MySugr Companion and Junior GlucoseBuddy Glooko Carb Count and Estimation Carbs&Cals FigWee Nutrition Scale (eatsmartproducts.com) Carb estimation Use a clenched fist for a 1 cup portion
LEARN AND APPLY: GLYCEMIC EFFECT Glycemic Index Rates how much blood sugar will increase over 2 hours (compared to glucose). On the glycemic index scale, foods rank between 0 and 100 (pure glucose has a glycemic index of 100). Foods are labeled as low-gi when they have a GI value of less than 55. Lentils = 40 Raw orange = 48 Glycemic Load Factors in the response to food based on portion eaten Corresponds to realistic portion sizes More accurately reflects the impact that the food will have on your blood sugar. Measurement is a scale of 1-20 A low glycemic load food has a GL value of 10 or less.
WHAT????? If we eat the portion of food (example: watermelon) that we want to eat, will it make a difference on our glucose outcomes despite the GI? To figure out glycemic load of the portion you are eating, use this formula: Glycemic index x Grams of carbohydrates in the portion you are eating / 100 Example: Watermelon has a very high GI value of 72. But the carbs in watermelon are highly diluted: each 120g (weighted portion, not carbs) serving of watermelon contains only 8.6g of carbohydrates. Thus, eating 50 g of carbohydrates corresponds to eating about 1.5 lbs worth of watermelon!!!! In this example a person eating a 120g weighted portion of 8.6g of carb would give a glycemic load of 72 (GI) x 8.6 (g of carb in portion) / 100 = 6.1 Glycemic load Relatively small glycemic effect despite a high glycemic index value. PORTION MATTERS In general, a low glycemic index food is a food with a GI value of 55 or less. A low glycemic load food has a GL value of 10 or less.
DIABETES CHANGES: SOCIAL SUPPORT 30 Years Ago Kids camps Adults mostly type 2 support groups No support for adults with type 1 diabetes Today Diabetes Blogosphere College support network Diabetes Online Community Web Journals Chat Rooms Webinars Podcasts Face-to-Face Conferences Athletic groups for those
30 YEARS FROM NOW You Did WHAT???
Work Towards a Cure But Care for Yourself Today! Jennifer C. Smith RD, LD, CDE (610)-642-6055 jennifer@integrateddiabetes.com www.integrateddiabetes.com www.type1university.com